Kenneth Glad
When a vaccine, ICU bed or costly drug cannot reach everyone, health systems often turn to formulas. New research suggests many people accept life-years as part of the equation, but not as the deciding factor.
A study published in The European Journal of Health Economics examined whether people prioritize saving more individuals or preserving more total years of life.
The research focused on a question that can shape decisions about vaccines, emergency care, organ transplants and publicly funded drugs.
The issue matters because rationing rules are not just technical tools. They can influence who receives treatment first when medicine, money or clinical capacity is limited.
Where formulas break
The study surveyed 14,345 adults in Australia, Brazil, Canada, Chile, China, Colombia, France, Italy, Spain, Uganda, the United Kingdom and the United States.
People were given a hypothetical COVID-19 vaccine allocation scenario. Doctors could give a hypothetical life-saving vaccine either to one 55-year-old with about 30 years left to live or to one or more 75-year-olds with about 10 years left.
When asked to choose between one 55-year-old and one 75-year-old, 66.8 percent favored the younger person.
A strict life-years calculation would place one 55-year-old on the same side of the scale as three 75-year-olds. But the average trade-off in the study was lower, at 2.45 older lives for one younger life.
Work changed answers
Work status changed how people answered. When both age groups had the same employment status, one 55-year-old was valued at about 2.34 people aged 75.
When the 55-year-old was working and the older people were not, the figure rose to 3.16.
When the older person was working and the younger person was not, support for saving the older person increased.
The findings complicate relying on QALYs alone. QALYs, or quality-adjusted life years, are a way of comparing treatments by estimating not only how many extra years of life they may provide, but how healthy those years are expected to be.
The study does not argue that public opinion should dictate medical policy. It suggests something narrower: People did not reject life-years, but they did reject treating them as the whole answer.
Source: The European Journal of Health Economics
